Operating on Anxiety: Negative Affect toward Breast Cancer and Choosing Contralateral Prophylactic Mastectomy

Michael C. Silverstein, Clara N. Lee, Laura D. Scherer, Crystal Phommasathit, Andrea L. Merrill and Ellen Peters
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Michael C. Silverstein: Department of Psychology, Center for Science Communication Research, University of Oregon, Eugene, OR, USA
Clara N. Lee: Department of Plastic and Reconstructive Surgery, College of Medicine, Division of Health Services Management and Policy, College of Public Health, OSU Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
Laura D. Scherer: School of Medicine on the Anschutz Medical Campus, University of Colorado, VA Denver Center for Innovation, Aurora, CO, USA
Crystal Phommasathit: Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
Andrea L. Merrill: Department of Surgery, Boston Medical Center, Boston, MA, USA
Ellen Peters: Center for Science Communication Research, School of Journalism and Communication, University of Oregon, Eugene, OR, USA

Medical Decision Making, 2023, vol. 43, issue 2, 152-163

Abstract: Background Rates of contralateral prophylactic mastectomy (CPM)—removal of the healthy breast following breast cancer diagnosis—have increased, particularly among women for whom CPM provides no survival benefit. Affective (i.e., emotional) decision making is often blamed for this increase. We studied whether greater negative breast cancer affect could motivate uptake of CPM through increased cancer risk perceptions and biased treatment evaluations. Methods We randomly assigned healthy women with average breast-cancer risk ( N = 1,030; M age = 44.14, SD = 9.23 y) to 1 of 3 affect conditions (negative v. neutral v. positive narrative manipulation) in a hypothetical online experiment in which they were asked to imagine being diagnosed with cancer in one breast. We assessed 1) treatment choice, 2) affect toward CPM, and 3) perceived risk of future breast cancer in each breast (cancer affected and healthy) following lumpectomy, single mastectomy, and CPM. Results The manipulation caused women in the negative and neutral narrative conditions (26.9% and 26.4%, respectively) to choose CPM more compared with the positive narrative condition (19.1%). Across conditions, women’s CPM affect did not differ. However, exploratory analyses addressing a possible association of affect toward cancer-related targets suggested that women in the negative narrative condition may have felt more positively toward CPM than women in the positive narrative condition. The manipulation did not have significant effects on breast cancer risk perceptions. Limitations The manipulation of affect had a small effect size, possibly due to the hypothetical nature of this study and/or strong a priori knowledge and attitudes about breast cancer and its treatment options. Conclusion Increased negative affect toward breast cancer increased choice of CPM over other surgical options and might have motivated more positive affective evaluations of CPM. Highlights This study used narratives to elicit different levels of negative integral affect toward breast cancer to investigate the effects of affect on breast cancer treatment choices. Increased negative affect toward breast cancer increased the choice of double mastectomy over lumpectomy and single mastectomy to treat a hypothetical, early-stage cancer. The narrative manipulation of negative affect toward breast cancer did not change the perceived risks of future cancer following any of the surgical interventions. Negative affect toward breast cancer may have biased affective evaluations of double mastectomy.

Keywords: affect; breast cancer decisions; contralateral prophylactic mastectomy; emotion; motivated reasoning; surgical decisions (search for similar items in EconPapers)
Date: 2023
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Persistent link: https://EconPapers.repec.org/RePEc:sae:medema:v:43:y:2023:i:2:p:152-163

DOI: 10.1177/0272989X221121134

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